I often get asked how to achieve hormonal balance without using hormone replacement therapy. This question typically comes from a woman who is not a candidate for HRT due to a personal or family history of breast cancer or from a younger woman who does not believe she is a candidate for hormones because she is still having periods. The truth is that both of these individuals may be appropriate for certain types of hormone therapies. However, to answer the question of hormone balancing without the use of hormone therapies, we must discuss what is happening during perimenopause with our hormones, and why we feel the need to be balanced.
Perimenopause is the transition period from normal menstrual cycles to menopause. The transition can take as long as 10 (or more) years and can start as early as 35. The average age of menopause in the United States is 52 years old so by your early to mid 40’s most of you will be in perimenopause. During this time, your body is still trying to produce a mature egg each month. Your pituitary gland is releasing Follicle Stimulating Hormone (FSH) which causes your ovaries to begin maturing eggs. Those maturing eggs begin releasing estrogen. If you have experienced normal menstrual cycles your entire adult life, you are used to fairly stable levels of estrogen and progesterone each month but as the number of remaining eggs in ovaries declines with age, hormones can begin to fluctuate wildly. You may experience very high or very low levels of estrogen.
Now, estrogen is normally thought to be a ‘feel good’ hormone, improving mood and cognition but when it is too low, it can cause hot flashes and night sweats, depression and anxiety, brain fog and memory issues. When it is too high it can cause headaches or migraines, insomnia, weight gain and bloating, hair loss and heavy or irregular menstrual cycles.
The ovaries are not the only place that estrogen is produced in the body. Peripheral fat cells also produce and store estrogen and serve as a storage depot for harmful compounds that come into the body, often referred to as toxins. Because those fat cells also release harmful cytokines, or chemical messengers that interact with every body system and cause inflammation throughout the body, we know that women who are above their ideal weight will tend to have menopausal symptoms that are worse and may have a more difficult transition during perimenopause.
So, those perimenopuasal years can feel chaotic to some women. If estrogen is swinging too high during the perimenopausal years, some women may need help balancing that estrogen through lifestyle measures to reduce excess fat, and to detox the body, or through the addition of progesterone.
When it comes to optimizing the detoxification pathways in your body to optimize your hormone balance, we will start with digestion and liver support. Then we will discuss exercise and sleep and finally environmental exposures. Most of these detox measures can also support optimization of body weight.
1. Let’s start with what you’re eating.
- You do need optimal amounts of protein, and good quality protein. Meat, eggs, seafood, plant-based protein and dairy are all good sources of protein. When possible source these items from grass-fed and grass-finished beef, or bison, free range chickens, or wild caught seafood.
- Fiber is the second most important and this is going to come primarily from vegetable sources, but don’t be afraid to have some starchy vegetables like sweet potatoes, whole grains, and rice. The goal is to have regular soft bowel movements. But the fiber is about far more than just managing constipation. It helps to normalize cholesterol and improves the health of your liver.
- Include healthy fats from olive oil, nuts, seeds and avocado as well as fatty fish in your diet.
- You need a variety of colorful vegetables for all of the unnamed nutrients that they hold. Cruciferous vegetables like broccoli, cauliflower, kale, brussels sprouts, and cabbage are especially good for balancing estrogen.
- Plenty of water. Make sure you stay well hydrated throughout the day. Especially if you are out in the heat or exercising. Consider adding electrolytes if you are actively sweating during the day. A water filter may be an important investment to consider.
- Try to include some bitter foods like arugula, because this helps your gallbladder work better.
- As well, try to find some fermented foods that you enjoy and can eat regularly. Pickled foods, kimchi, sauerkraut, kombucha, miso, yogurt or kefir and apple cider vinegar.
- In terms of foods to avoid: highly processed foods, sweetened beverages, cakes, cookies, treats, fruit juices. Alcohol is another big one to avoid or reduce. In fact, many women find that eliminating alcohol is the most impactful change they make during this time period as it improves their sleep, reduces night sweats and makes weight loss easier.
2. Supplements.
- You may want to consider taking digestive enzymes if you are not already. Our stomach tends to not produce digestive enzymes as well once we get to age 40.
- Also a good quality probiotic. I like and recommend the Pendulum brand.
- If you’re not doing a magnesium supplement, you might go with a brand that gives you two different types of magnesium because you could benefit from NeuroMag which crosses the blood barrier and helps you sleep, but you could also benefit from a good old-fashioned magnesium citrate, which should help soften stool.
- Medications can cause your liver to be sluggish and slow down the detox pathways. Especially be cautious of overusing Tylenol.
- Ask me to add you to my supplement store where you can find the highest quality supplement brands with my personalized recommendations at a discount.
3. Exercise.
We talk at length about the role of exercise for overall health, muscle maintenance, joint flexibility and agility, and metabolic rate. However, exercise serves an important role in the detox pathways of your body as well. Exercise increases circulation of blood and lymph and also increases your respiratory rate. It is also associated with sweating. All of these serve to speed up the detoxification pathways in your body. There is also evidence that exercise strengthens the mitochondria in your liver, one of the major detox organs in your body, responsible for managing inflammation, metabolizing fats, and turning nutrients into energy. So keep moving! On days that you do not work up a sweat through exercise, inducing sweat through sauna will bring similar benefits.4. Sleep.
The unsung hero of detoxification. Nothing comes together without good quality sleep. During deep sleep your brain’s glymphatic system clears out toxins and debris from the brain and flushes it away. During sleep your body clears out free radicals, releases both melatonin and glutathion which are involved in free radical scavenging and binding of heavy metals for elimination through the bowels. Lack of good quality sleep can increase risk of oxidative stress in the body. Aim for at least 6 hours, optimally tracking your sleep to improve the amount of deep sleep you get each night and to wake feeling energized and well-rested.Let’s take a look at environmental exposures, and try to clean those up where possible without being overly anxious about it. The truth is, we are hearing a lot about micro-plastics in our environment and in our bodies. These are compounds that do not degrade and break down over time. Our personal efforts to reduce exposure is unlikely to make a large impact on the environment but we may be able to reduce some of the cumulative effect these compounds have over time. In personal care products such as shampoos, sunscreen, lotions and makeup, avoid: parabens, phthalates, petroleum based products etc. Refer to the Environmental Working Group website for more information on cleaning up the products you use on your skin and in your home. https://www.ewg.org/
Try to get away from storing or carrying food or water in plastic containers, especially do not reheat in plastic. Glass or BPA free water bottles are a great alternative.
Don’t try to tackle all of these changes at once. Start with one area and make a few small changes. Then build on those new habits by adding a few more small changes. If you continue to struggle with what feels like hormonal imbalance during the perimenopausal transition, let’s schedule an appointment to discuss your symptoms and put into action a plan that will get you feeling like yourself again!